Ankle sprains represent one of the most common injuries to the leg and I see them happen all the time in my running groups on facebook as well as athletes and weekend warriors that end up on my table. Ankle sprains are found to happen more often in women than men as well as in children and adolescents than in adults.
Grade I ankle sprains involve stretching of the ligaments without any tearing. This typically results in mild pain, swelling and stiffness.
Grade II ankle sprains involve partial tearing of the ligament(s) and usually cause moderate pain, swelling, bruising and difficulty walking.
Grade III ankle sprains involve complete tearing of one or more ligaments and result in severe pain, swelling, bruising, and often the inability to bear weight on the affected ankle.
Ankle sprains can be caused by a variety of factors such as uneven surfaces, sudden changes in direction, poor footwear, and weak ankle muscles. Treatment for ankle sprains varies depending on the severity of the injury but typically involves rest, ice, compression, and elevation (RICE therapy). In some cases, physical therapy or surgery may be necessary.
Prevention of ankle sprains can be achieved through proper warm-up and stretching, wearing appropriate footwear, strengthening the ankle muscles through exercises, and avoiding uneven terrain and sudden changes in direction during physical activity.
It is important to seek medical attention if you suspect you have an ankle sprain and to follow the recommended treatment plan to avoid further injury and ensure proper healing.
Taking a conservative approach to management is the initial treatment option for ankle sprains.
Joint mobilization techniques like; Passive Range of Motion (PRM), where the therapist moves the foot through its range of motion with no help from the client shows significant and immediate benefits for improving dynamic balance and weight-bearing ankle dorsiflexion range of motion in patients with ankle sprains. NSAIDs or nonsteroidal anti-inflammatory drugs, early mobilization, exercise therapy, and massage therapy decrease pain and function in acute ankle sprains. But that doesn't always prevent ankle instability. About 50% of individuals with lateral ankle sprains are commonly diagnosed as having ankle instability. Chronic ankle instability carries symptoms like:
Occasional swelling
Impaired strength
Instability
Impaired balance
Functional ankle instability can be defined as recurrent ankle sprains or ongoing sensations of the ankle giving way with normal ankle motion and the absence of joint laxity. Some studies have reported that manual therapy, including joint mobilization techniques are effective for the management of ankle instability.
Neuromuscular/proprioceptive interventions are the most appropriate for the treatment of ankle instability, which suggests that the targeted structure of the management of ankle instability is the musculature. Factors that contribute to functional ankle instability include:
Muscle weakness
Impaired muscle recruitment patterns
Reduced ankle range of motion
Balance deficits
Impaired joint proprioception
Often there is a delayed fibularis muscle reaction time in subjects with ankle instability. Manual Resistive Therapy (MRT) is one of the techniques I use to bring back stability to the ankle. A non-reacting fibularis muscle function can give patients a sense of instability, even in a mechanically stable ankle. The fibularis muscles, like most other lower extremity muscles, frequently function to control movement rather than to produce it. The fibularis muscles all act to evert (turn out) the non-weight-bearing foot. The difference in these muscles is that the fibularis tertius muscle dorsiflexes the foot because its tendon crosses in front of the ankle joint, whereas the fibularis longus and fibularis brevis muscles plantar flex the foot because their tendons pass behind the ankle joint. During jogging, standing, and walking the fibularis longus and brevis function through eccentric contractions in the stance phase when the foot is fixed in contrast the fibularis tertius works primarily through the swing phase in conjunction with extensor digitorum longus and tibialis anterior muscles to clear the foot.
In my initial evaluation of a client with an ankle sprain, I start with an assessment of the injury. I look for swelling, tenderness at the posterior edge or tip of the lateral malleolus, tenderness at the posterior edge or tip of the medial malleolus, and/or inability to bear weight (including limping). Pain distribution and referral, or the presence of paresthesia. Palpation of the ligaments of the ankle and foot joints, passive and active ankle range of motion in both weight-bearing and non-weight-bearing positions of the foot, and perform specific orthopedic tests. For example the anterior drawer test for assessing the integrity of the anterior inferior tibiofibular ligament and the medial talar tilt test for assessing the amount of talar inversion occurring within the ankle mortise.
During the initial massage session, I am looking for associated trigger points in the tibialis anterior, gastrocnemius & soleus muscles which can be related to symptoms associated with ankle sprains. I may perform passive range of motion techniques and stretches, lymphatic massage to decrease swelling, and target all of the muscles that may have become excessively tonus due to compensation of the injury. Typically 6 - 10 sessions are needed to treat ankle sprains including techniques like manual resistive therapy to increase the strength & functionality of the ankle, stretch therapy to increase the range of motion in the joints and muscles, and manual therapy to relieve tension and trigger points.
My typical massage treatment plan for ankle sprains is as follows:
Acute Stage: 1 - 7 days.
Duration at the site of injury 15 - 20 minutes
Lymphatic facilitation. The client is also taught self-treatment of opening the neck protocol and exhale-crunch lymphatic techniques for home care.
Neuromuscular release: Posterior compartment of the leg, and thigh.
Light Swedish full body massage.
Subacute Stage: day 4 - 6 weeks
Duration at the site of injury 15 - 20 minutes
Continue lymphatic facilitation. Gradually the swelling is reduced and site-specific work begins to be focused on the damaged ligaments.
Neuromuscular release, adding the lateral and anterior compartment muscles of the leg.
Begin massaging with deep transverse friction, but at the end of the sub-acute stage when swelling is sufficiently reduced, and there is no discoloration of tissue over the damaged ligament(s). I may either end the massage with ice or lymphatic facilitation or both.
Maturation Stage: 2-3 weeks - months or years.
Duration at the site of injury: 15 minutes
Deep transverse friction after maybe some heat has been applied.
Neuromuscular release and lymphatic facilitation as necessary.
Trigger point therapy for all the major muscle groups in the lower extremities.
Why wait days, weeks, or months to get back to your active lifestyle? Book your sessions today.
References: Myofascial Pain and Dysfunction, Principles of Athletic Training, Therapeutic Massage for Athletes.
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If you have never had a massage before and are not sure whether massage is appropriate for you or your conditions feel free to email me michaelhale@gmf.one.
Michael Hale is a Neuromuscular Therapist, Personal Trainer, and Health Educator who graduated from National Holistic Institute (NHI) and International Sports Science Association (ISSA). He wholeheartedly believes that strengthening the body is equally as important as relaxing the body in order to reach homeostasis.
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